OUtMATCH: Omalizumab and OIT Similarly Enable Allergenic Food Consumption, With Robert Wood, MD

The question driving food allergy research has shifted — from whether patients can be protected against accidental exposures to whether they can actually eat the foods they've spent their lives avoiding. Stage 3 data from the landmark OUtMATCH trial presented at the American Academy of Allergy, Asthma & Immunology (AAAAI) 2026 Annual Meeting held in Philadelphia, Pennsylvania, from February 27 to March 2, suggest the answer, for the majority of patients, is yes — and that both available treatments get them there comparably.1

To discuss the findings, we spoke with Robert A. Wood, MD, Chief of the Eudowood Division of Pediatric Allergy and Immunology at Johns Hopkins Children's Center and Professor of Pediatrics at the Johns Hopkins University School of Medicine in Baltimore, and an investigator of OUtMATCH, the multi-stage trial that led to FDA approval of omalizumab for food allergy in 2024.2 Stage 3 addressed the most clinically meaningful question yet: after approximately 52 weeks of either multi-food OIT (mOIT) or omalizumab, could patients successfully introduce and sustain dietary consumption (DC) of their allergenic foods? Of 81 eligible participants, 80 qualified for DC plans following mOIT (n = 29) or omalizumab (n = 51), covering 83 and 139 individual allergen DC plans, respectively. Success was defined as consuming a median of ≥300 mg/day of allergenic food at both 3 and 6 months by daily diary, with additional study team evaluations conducted across all 12 months.

By daily diary, DC plan success rates across all foods showed no significant differences between groups at 3 months (post-mOIT 77% vs. post-omalizumab 66%; P = .10) or 6 months (65% vs. 63%; P = .77). Peanut-specific outcomes mirrored this pattern: post-mOIT 77% and 65% at 3 and 6 months versus post-omalizumab 67% and 60% (P = .43 and P = .80, respectively). Study team evaluations likewise showed no group differences at 3, 6, 9, or 12 months across all foods (post-mOIT: 90%, 82%, 75%, 67%; post-omalizumab: 91%, 82%, 69%, 63%; P range = 0.44–1.00), with comparable individual allergen outcomes (P range = 0.13–1.00).

Safety profiles were similar among the 52 participants who maintained DC plans for all three foods across 12 months (n = 22 post-mOIT; n = 30 post-omalizumab), with any adverse event reported in 86% (19/22) post-mOIT and 93% (28/30) post-omalizumab. Two serious adverse events occurred during the open feeding transition from mOIT to DC, and 1 case of eosinophilic esophagitis developed during DC post-omalizumab. The tolerability gap between the 2 treatments, however, loomed large in context: roughly half of mOIT patients in Stage 2 could not tolerate the regimen well enough to advance to Stage 3 at all — making omalizumab the more accessible path for a substantial portion of patients. As Wood noted, treatment selection ultimately comes down to the individual: "a very few, let's say teenagers with peanut allergy, are asking to eat peanut — most everyone, if they could, would say, 'Can I eat pizza?' It gets individualized in our clinic for every patient now."

Wood’s disclosures include Aimmune, ALK, DBV Technologies, FARE, Genentech, NIAID, Novartis, Regeneron, Siolta, and Aravax.

References

1. Chinthrajah RS, Lanser B, Leung D, et al. Evaluation of dietary consumption feasibility following treatment with multi-food oral immunotherapy or omalizumab in OUtMATCH. Presented at: AAAAI 2026 Annual Meeting, February 27-March 2, Philadelphia, Pennsylvania. Abstract #L22

2. Smith T. FDA Approves Omalizumab as First Treatment of 1 or More Food Allergies for Children, Adults. Article. HCPLive. February 16, 2024. https://www.hcplive.com/view/fda-approves-omalozumab-first-treatment-of-1-or-more-food-allergies-for-children-adults